Benefits of quitting The reports of the US Surgeon General on the health consequences of smoking, released in 1990 and 2004, summarize abundant and significant health benefits associated with giving up tobacco [9,104]. Benefits noticed shortly after quitting (e.g., within 2 weeks to 3 months), include improvements in pulmonary function and circulation. Within 1–9 months of quitting, the ciliary function of the lung epithelium is restored. Initially, patients might experience increased coughing as the lungs clear excess mucus and tobacco smoke particulates. In several months, smoking cessation results in measurable improvements of lung function. Over time, patients experience decreased coughing, sinus congestion, fatigue, shortness of breath, and risk for pulmonary infection and 1 year postcessation, the excess risk for coronary heart disease is reduced to half that of continuing smokers. After 5–15 years, the risk for stroke is reduced to a rate similar to that of people who are lifetime nonsmokers, and 10 years after quitting, an individual’s chance of dying of lung cancer is approximately half that of continuing smokers. Additionally, the risk of developing mouth, larynx, pharynx, esophagus, bladder, kidney, or pancreatic cancer is decreased. Finally, 15 years after quitting, a risk for coronary heart disease is reduced to a rate similar of that of people who have never smoked. Smoking cessation can also lead to a significant reduction in the cumulative risk for death from lung cancer, for males and females. Smokers who are able to quit by age 35 can be expected to live an additional 6–9 years compared to those who continue to smoke [105]. Ossip-Klein et al. [106] recently named tobacco use a “geriatric health issue.” Indeed, a considerable proportion of tobacco users continue to smoke well into their 70s and 80s, despite the widespread knowledge of the tobacco health hazards. Elderly smokers frequently claim that the “damage is done,” and it is “too late to quit;” however, a considerable body of evidence refutes these statements. Even individuals who postpone quitting until age 65 can incur up to four additional years of life, compared with those who continued to smoke [24,106]. Therefore, elderly smokers should not be ignored as a potential target for cessation efforts. Health care providers ought to remember that it is never too late to advise their elderly patients to quit and to incur health benefits. A growing body of evidence indicates that continued smoking after a diagnosis of cancer has substantial adverse effects. For example, these studies indicate that smoking reduces the overall effectiveness of treatment, while causing complications with healing as well as exacerbating treatment side effects, increases risk of developing second primary malignancy, and decreases overall survival rates [36–38,107–109]. On the other hand, the medical, health, and psychosocial benefits of smoking cessation among cancer patients are promising. Gritz et al. [37] indicated that stopping smoking prior to diagnosis and treatment can have a positive influence on survival rates. Although many smoking cessation interventions are aimed at primary prevention of cancer, these results indicate that there can be substantial medical benefits for individuals who quit smoking after they are diagnosed with cancer.
Smoking cessation interventions Effective and timely administration of smoking cessation interventions can significantly reduce the risk of smoking-related disease [110]. Recognizing the complexity of tobacco use is a necessary first step in developing effective interventions and trials for cessation and prevention. The biobehavioral model of nicotine addiction and tobacco-related cancers presents the complex interplay of social, psychological, and biological factors that influence tobacco use and addiction (Figure 1.1). These factors in turn mediate dependence, cessation, and relapse in most individuals, and treatment has been developed to address many of the factors noted in the model [38].
The health care provider’s role and responsibility Health care providers are uniquely positioned to assist patients with quitting, having both access to quitting aids and commanding a level of respect that renders them particularly influential in advising patients on health-related issues. To date, physicians have received the greatest attention in the scientific community as providers of tobacco cessation treatment. Although less attention has been paid to other health care providers such as pharmacists and nurses, they too are in a unique position to serve the public and situated to initiate behavior change among patients or complement the efforts of other providers [64,111]. Fiore and associates conducted a meta-analysis of 29 investigations in which they estimated that compared with smokers who do not receive an intervention from a clinician, patients who receive a tobacco cessation intervention from a physician clinician or a nonphysician clinician are 2.2 and 1.7 times as likely to quit smoking at 5 or more months postcessation, respectively [112]. Although brief advice from a clinician has been shown to lead to increased likelihood of quitting, more intensive counseling leads to more dramatic increases in quit rates [112]. Because the use of pharmacotherapy agents approximately doubles the odds of quitting [7,112], smoking cessation interventions should consider combining pharmacotherapy with behavioral counseling. To assist clinicians and other health care providers in providing cessation treatment, the US Public Health Service has produced a Clinical Practice Guideline for the Treatment of Tobacco Use and Dependence [112]. The Guideline is based on a systematic review and analysis of scientific literature which yields a series of recommendations and strategies to assist health care providers in delivering smoking cessation treatment. The Guideline emphasizes the importance of systematic identification of tobacco users by health care workers and offering at least brief treatment interventions to every patient who uses tobacco. Among the most effective approaches for quitting are behavioral counseling and pharmacotherapy, used alone or, preferably, in combination
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